Unsafe abortion remains a leading cause of maternal death and injury in Ghana. Now, a newly released study finds that a woman's socioeconomic status largely determines how safe her abortion will be. The study, "Factors Associated with Abortion-Seeking and Obtaining a Safe Abortion in Ghana," by Aparna Sundaram et al., of the Guttmacher Institute, found that while middle- and upper-income women in urban areas are more likely than other women to obtain an abortion, women who are young, poor or without support of a partner are at greatest risk of having an unsafe abortion and experiencing injury or death.

"As is too often the case, access to quality health services is being determined by circumstances other than need, with the less well-off experiencing the worse outcomes" said Joana Nerquaye-Tetteh, a noted reproductive health expert working with the Guttmacher Institute in Ghana. "The tragic reality is that many women continue to put their health and lives at risk to terminate a pregnancy, going to untrained providers or worse, attempting to self-induce. The resulting harm would be avoided if existing guidelines were actually implemented."

The researchers, who analyzed data from the 2007 Ghana Maternal Health Survey, found that wealthier women were three times more likely to have a safe procedure than poorer women. They also found that women who had financial support from their partners were more likely to have a safe procedure. A majority of women whose partner paid for some or all of the expenses had a safe abortion (67%), while a minority of women whose partners did not contribute (44%) did so.

Age was also associated with a woman's ability to obtain a safe procedure: Adolescents were especially vulnerable to having unsafe abortions. Teens were 77% less likely to have a safe procedure than women in their 30s and 60% less likely to do so than women in their 20s. The researchers attribute this disparity to adolescents having less knowledge about where to obtain an abortion and poorer access to financial resources, and being more concerned about stigma and less likely to ask for help. Previous studies have documented that even when safe legal options are available, the stigma associated with abortion is so powerful that it often leads women to seek an unsafe, clandestine abortion.

"Our analysis makes clear that there is an urgent need to develop and enforce policies and programs to lower unintended pregnancy rates and improve access to contraception and safe abortion services, especially among economically and socially disadvantaged women," said Aparna Sundaram, lead author of the study.

The researchers noted other important factors that lead women to obtain unsafe procedures, such as a limited number of qualified abortion providers and lack of awareness of Ghana's fairly liberal abortion law. They stress that in order to reduce the incidence of unsafe abortion and its harmful consequences, efforts must be made to destigmatize the procedure and educate women and the general population about the legal status of abortion in Ghana.